In A Nutshell

Initially, most Ebola patients died, so there weren’t enough survivors to give us good information on the long-term effects of the disease. However, we’re now learning that Ebola may continue to infect survivors in certain parts of the body—such as the eyes, brain, ovaries, and testicles—that are protected from our immune systems. Men are now advised to use condoms indefinitely to avoid spreading the disease through unprotected sex. Many survivors are also at risk of developing blindness, deafness, joint pain, chronic headaches, and more. In one case, an Ebola survivor’s eye turned from blue to green while his eye was infected with the virus.

The Whole Bushel

Initially, most Ebola patients died, so there weren’t enough survivors to give us good information on the long-term effects of the disease. However, we’re now learning that Ebola may continue to infect survivors in “immune privileged” parts of the body, such as the eyes, brain, ovaries, and testicles. These areas are protected from our immune system, so the molecules that fight infections can’t harm the most important survival and reproductive mechanisms of our bodies. In particular, the testes are set up to protect sperm from all invaders. If immune cells do find a way in, they’ll meet molecules to suppress them.

Unfortunately, this leaves the sexual partners of Ebola survivors at risk of transmission of the disease through unprotected sex. Previously, doctors had advised patients to use a condom for a minimum of three months after they survived the infection. But there have been isolated cases of transmission after that time.

At first, doctors weren’t sure if the disease had been sexually transmitted. But around March 2015, doctors matched genetic material from the virus in a survivor’s semen to the Ebola infection found in his female partner. Other than having unprotected sex with the Ebola survivor about five months after he was believed to be cured, the woman supposedly had no other exposure to the virus. As a result, the CDC now recommends that male Ebola survivors use condoms indefinitely for anal, oral, or vaginal sex.

But the lingering problems for Ebola survivors don’t stop there. Many survivors are also at risk of developing blindness, deafness, severe joint and muscle pain, chronic headaches, and extreme fatigue. Some women don’t have menstrual periods for months. “We’re seeing symptoms in patients who’ve been out of the treatment unit for up to nine months,” said Dr. John Fankhauser of ELWA Hospital in Monrovia, Liberia. “They’re still very severe and impacting their life every day.”

In Ebola survivor Dr. Ian Crozier’s case, his left eye turned from blue to green when the virus flared up in that eye less than two months after he had supposedly been cured. Initially, he had become infected while volunteering to help Ebola patients in Sierra Leone. Crozier then endured a long battle against the virus, almost losing his life before finally appearing to beat the disease in October 2014. When he returned to Emory Hospital a couple of months later with complaints of pain and fading vision, his doctors were amazed to find the virus still hiding in his eye. No one had thought that possible.

However, the virus was not found on the surface of his eye or in his tears, so there was no risk of transmission in casual contact. Crozier also suffered from extreme fatigue, hearing loss, and joint and muscle pain.

Doctors diagnosed him with uveitis, inflammation inside the eye that can cause blindness. They feared that the virus could spread to Crozier’s right eye. But they had no tested protocol to treat an eye infection of this type.

First, doctors gave Crozier high doses of the steroid prednisone to lessen the eye inflammation. But his vision continued to get worse. Ten days after his eye symptoms appeared, the iris in his left eye changed from bright blue to bright green. As he wasn’t showing any improvement, doctors started him on an experimental antiviral drug.

About a week later, Crozier began to get small areas of his vision back. Eventually, he regained his sight and his original eye color. But it took a few months. Doctors still aren’t sure if the antiviral drug or his immune system is responsible for his recovery.